A Prospective Study of Gluten Transfer Through Kissing in Celiac-Discordant Couples

Anne R Lee; Zhijun Chen; Jackie Jossen; Jessica Lebovits; Benjamin Lebwohl; Suzanne K Lewis; Suneeta Krishnareddy; Randi L Wolf; Luke Emerson; Peter H R Green

doi:10.1053/j.gastro.2026.01.024

A Prospective Study of Gluten Transfer Through Kissing in Celiac-Discordant Couples

Gastroenterology. 2026 Apr 8:S0016-5085(26)00091-0. doi: 10.1053/j.gastro.2026.01.024. Online ahead of print.

Authors

Affiliations

¹ Celiac Disease Center, Department of Medicine, Columbia University, New York, New York. Electronic address: arl2004@cumc.columbia.edu.
² Teachers College, Columbia University, New York, New York.
³ Celiac Disease Center, Department of Medicine, Columbia University, New York, New York.
⁴ Celiac Disease Center, Department of Medicine, Columbia University, New York, New York; Teachers College, Columbia University, New York, New York.
⁵ Bia Diagnostics, Colchester, Vermont.

PMID: 41949530
DOI: 10.1053/j.gastro.2026.01.024

Abstract

Background & aims: Current management of celiac disease (CeD) depends on a restrictive gluten-free diet (GFD). Studies have reported CeD patients' anxiety about gluten transfer via kissing, but data to support this concern are lacking.

Methods: To assess the transfer of gluten through kissing, the non-CeD partner consumed a gluten load (10 crackers with 59,107 ppm or 590 mg gluten). In 2 protocols, after consuming the gluten load, the non-CeD partner kissed the partner with CeD. In the first kissing protocol, the non-CeD partner waited 5 minutes before kissing, and in the second, the non-CeD partner drank 4 oz of water and then immediately kissed the partner with CeD. Saliva was collected from the partner with CeD immediately after the kiss. Gluten in saliva was assessed by R-5 enzyme-linked immunosorbent assay test method and in the urine by GlutenDetect (Glutenostics, Inc).

Results: Gluten was detectable in the saliva of the non-CeD partner in all protocols (80 ppm to >25,000 ppm). The amount detected in the saliva of those with CeD varied from <5 ppm to 153.9 ppm. Only 2 of the 20 gluten exposures tested >20 ppm gluten, the level defined as gluten free. None of the saliva samples tested >20 ppm when the non-CeD partner drank 4 oz of water after eating the gluten load.

Conclusions: There was not an increased risk of significant gluten transfer when kissing. Drinking 4 oz of water before kissing further reduces the risk. These results should guide our clinical practice and should be shared with our patients to help reduce the burden of the diet.

Keywords: Celiac Disease; Gluten Exposure; Gluten Free Diet; Kissing.